COMMUNITY HEALTH CENTERS OF SOUTHEASTERN IOWA INC NPI 1295705622

NPI Information

NPI: 1295705622
Provider Name: COMMUNITY HEALTH CENTERS OF SOUTHEASTERN IOWA INC

Doing Business As: TRI-STATE MEDICAL GROUP INC

Classification: Clinic/Center - 261QF0400X
Entity Type: Organization

Specialization: Federally Qualified Health Center (FQHC)

Address:
345 POLK ST
WARSAW, IL
ZIP 62379
Phone: (217) 256-3013
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COMMUNITY HEALTH CENTERS OF SOUTHEASTERN IOWA INC is a federally qualified health center (fqhc) clinic center in Warsaw, IL. COMMUNITY HEALTH CENTERS OF SOUTHEASTERN IOWA INC NPI is 1295705622. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Tri-state Medical Group Inc.

The provider's business location address is:

345 POLK ST
WARSAW, IL
ZIP 62379-033
Phone: (217) 256-3013
Fax: (319) 753-2301

The provider's authorized official is April K Schnedler .
The authorized official title is Lead Billing Coordinator and has the following contact phone number (319) 768-5809.

The enumeration date for this NPI number is 1/26/2006 and was last updated on 10/19/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207Q00000X	Family Medicine				No
2	261QF0400X	Clinic/Center	Federally Qualified Health Center (FQHC)			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	141934	MEDICARE OSCAR/CERTIFICATION	ILLINOIS
2	=========002	MEDICAID	ILLINOIS
3	=========	OTHER		AETNA
4	203427	MEDICARE PIN	ILLINOIS
5	=========	OTHER		TRI-WEST
6	=========	OTHER		JOHN DEERE HEALTHCARE
7	0563882	MEDICAID	IOWA
8	3422957	OTHER	ILLINOIS	BLUE CROSS BLUE SHIELD
9	506089424	MEDICAID	MISSOURI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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